Level IV, prognostic case series.

Background:The treatment of osteochondral lesions of the talus (OLTs) with a juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large OLTs, the potential advantage of a particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach, nor have any compared an arthroscopic technique with an open approach.Purpose:To compare the outcomes of an arthroscopic transfer technique with the previously published open technique.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 34 patients (mean age, 33 years) underwent treatment of talar cartilage lesions with a DeNovo NT Natural Tissue Graft. Of these treatments, 20 were performed arthroscopically and 14 were performed with open arthrotomy. There was no statistically significant difference between the groups with respect to age, lesion width, lesion depth, lesion length, or operative time. The mean lesion area was 107 mm2. The scores from 6 different validated outcome measures were recorded for patients in each group preoperatively and subsequently at 6 months, 1 year, 18 months, and 2 years.Results:Comparing outcome scores at each time point to baseline, there were no statistically significant postoperative differences found between open and arthroscopic approaches with regard to the visual analog scale (VAS) for pain (P = .09), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale (P = .17), Foot and Ankle Ability Measure (FAAM)–sports subscale (P = .73), Short Form–12 (SF-12) physical health summary (P = .85), SF-12 mental health summary (P = .91), or FAAM–activities of daily living subscale (P = .76).Conclusion:The treatment of talar articular cartilage lesions with a DeNovo NT Natural Tissue Graft demonstrated no significant differences in outcome at 2 years regardless of whether the graft was inserted with an arthroscopic or open technique.Clinical Relevance:Our analysis demonstrated no significant difference between an arthroscopic versus open approach at any time point for the first 2 years after implantation of a juvenile particulated cartilage allograft for large OLTs. With that said, both groups demonstrated improvement from baseline. These findings indicate that surgeons with different levels of comfort utilizing arthroscopic techniques can offer this treatment modality to their patients without altering their planned surgical approach. In addition, this will be particularly helpful in counseling patients for surgery when the extent of the defect will be evaluated intraoperatively. Patients can be counseled that they will likely have the same incisions regardless of whether they require debridement, microfracture, or implantation of a particulated allograft.

Purpose of reviewAs violent crime in the US continues to rise, unfortunately so does the incidence of gunshot wounds and other penetrating injuries to the spine increase. As well, our understanding of the mechanisms of injury and the body's response to injury develops, and consequently, treatment algorithms evolve. The purpose of this review is to discuss the current recommendations for these types of injuries. Recent findingsIn the past year, there has been little advancement in the management of penetrating thoracolumbar spine injuries. Certainly our understanding of these injuries continues to evolve, but the treatment algorithms remains static at this point. With the continued research into the secondary mechanisms of spinal cord injury, and advanced pharmacologic management, these algorithms will certainly evolve. Summary To date, indications for acute surgical management of penetrating spine injuries have not changed, and are currently limited to progressive neurologic deficits, spinal column instability, intradural copper fragmentation, and perhaps cerebrospinal fluid fistula. As other management strategies evolve, our management will also evolve.

The recent conflicts in Iraq and Afghanistan have resulted in severe foot and ankle wounds to many United States service members. Amputation of the severely damaged extremity often is the only option, while amputation of the potentially salvageable extremity may be chosen by the patient and the surgeon as the preferred reconstructive treatment.1 When salvage is pursued, enormous challenges are encountered in managing the complex wounds of war. The cumulative experiences of military surgeons have been invaluable in advancing reconstructive surgery of the war-wounded foot and ankle.2,3 This work details the experiences of United States military reconstructive surgeons in the soft tissue management of the war wounds of the foot and ankle resulting from the conflicts in Iraq and Afghanistan.

Cephalomedullary nail fixation of open Type-III wartime subtrochanteric and pertrochanteric femoral fractures can be reliably used to effect fracture union in a timely manner. The most frequent complications of treatment are wound infection and symptomatic heterotopic ossification.